More minimally invasive cancer treatment on the horizon

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Interventional oncology has emerged as the preferred treatment method in recent years, J. William Charboneau, MD, department of radiology at the Mayo Clinic in Rochester, Minn., confirmed on Monday as he delivered the Eugene P. Pendergrass New Horizons Lecture, “Image-guided Cancer Treatment: The Science and Vision of an Emerging Field.”

Charboneau cited a male patient who had a surgical resection in 2002 for a lesion. That procedure cost $33,000 and required 35 days of recovery. When he had another lesion in 2005, he underwent percutaneous ablation which cost about $7,000 and only required only two days of recovery time.

Scholarship is one way to track the emergency of newer treatments, Charboneau said. In 1996, almost no abstracts on minimally invasive procedures were presented for RSNA. This year, 450 abstracts were submitted to RSNA. For a treatment method to move from experimental to widespread acceptance, it must demonstrate effectiveness in local control, patient survival and improved quality of life. It must offer greater effectiveness and safety, lower invasiveness and costs, and be easy to perform and broadly applied.

Charboneau discussed osteoid osteoma, one of the most difficult cancers to treat. Because it’s difficult to get to, open surgical resection had only a 70 percent success rate. Radiofrequency (RF) ablation has a greater than 90 percent success rate. When you consider costs, quality of life, side effects, and almost any other measure, RF ablation is superior.

Clearly, there is plenty of incentive to move minimally invasive techniques to the forefront.

One way to do that is the development of greater precision of treatment. That impacts pretreatment planning and navigation and guidance. The current limitations are quite significant, Charboneau said. They include unpredictable ablation size, shape and margin, and the fact that pre-procedural CT and MR images are often not contemporaneous with the procedure. “We need comprehensive simulation that displays the tumor and ablation zone in 3D considering the organ, type of cancer, heat sink from large vessels and potential for collateral damage.

Using robotics is the best way to improve navigation and guidance, Charboneau said. Robotics allow precise placement for small masses, moving targets, and large masses where multiple applicators are needed.

Innovation is the theme of all the advances, he said. “It is key to our continued success. There are many reasons to be excited about what is to come.” Not the least of which is that new treatments offer patients hope.